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Relapses and obstetric outcomes in women with multiple sclerosis planning pregnancy

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Abstract

Objective

To evaluate the effect of discontinuation of different disease-modifying therapies (DMTs) before pregnancy with respect to the occurrence of relapses and pregnancy outcomes.

Methods

Women with multiple sclerosis who desire to bear children were followed prospectively. Demographic data, clinical characteristics, and the information on the use of DMTs were collected. A multivariate analysis was used to assess the relationship between relapses and the prior use of different DMTs.

Results

The present study assessed 75 consecutive pregnancy plans (66 women), 65 of which resulted in pregnancy. The mean age of the participants was 32.1 ± 4.2 years, and the mean disease duration was 6.1 ± 4.2 years. No relapses before pregnancy were reported in the group of women who maintained their DMT until pregnancy confirmation, while 14 relapses were reported in 12/42 women (29%) who discontinued DMT before pregnancy. During pregnancy, patients on natalizumab or fingolimod before pregnancy had a higher rate of relapses. Most women restarted their previous DMT after delivery within the first trimester. The relapse rate in postpartum was 0.07.

Conclusions

Disease-modifying therapies received influences the risk of relapse and disease progression from women who are planning pregnancy. The risk of relapse during pregnancy was significantly higher in the group of women treated with natalizumab or fingolimod compared to the group of women treated with interferon beta or glatiramer acetate. The postpartum risk of relapses was lower than that found in previous reports.

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Acknowledgements

The authors thank Dr. Santiago Mola and Dr. Arantxa Alfaro for their assistance with data acquisition.

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Authors and Affiliations

  1. Neurology Service, Hospital Marina Baixa, Alicante, Spain

    Leticia Berenguer-Ruiz

  2. Neurology Service, Hospital General Universitario de Alicante, 03010, Alicante, Spain

    Juana Gimenez-Martinez & Angel Perez Sempere

  3. Department of Clinical Medicine, Miguel Hernández University, Sant Joan d’Alacant, Spain

    Antonio Palazón-Bru & Angel Perez Sempere

Authors
  1. Leticia Berenguer-Ruiz
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  2. Juana Gimenez-Martinez
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  3. Antonio Palazón-Bru
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  4. Angel Perez Sempere
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Corresponding author

Correspondence to Angel Perez Sempere.

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Conflicts of interest

Leticia Berenguer-Ruiz has received personal compensation for consulting, serving on a scientific advisory board or speaking with Almirall, Biogen Idec, Merck Serono, Novartis, Sanofi-Aventis and Teva. Juana Gimenez-Martinez has received speaker honoraria from Almirall, Biogen Idec and Sanofi-Aventis. Antonio Palazón-Bru reports no disclosures. Angel P. Sempere has received personal compensation for consulting, serving on a scientific advisory board or speaking with Almirall, Biogen Idec, Bayer Schering Pharma, Merck Serono, Novartis, Roche, Sanofi-Aventis and Teva.

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Berenguer-Ruiz, L., Gimenez-Martinez, J., Palazón-Bru, A. et al. Relapses and obstetric outcomes in women with multiple sclerosis planning pregnancy. J Neurol 266, 2512–2517 (2019). https://doi.org/10.1007/s00415-019-09450-6

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  • DOI: https://doi.org/10.1007/s00415-019-09450-6

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